Located in rural Appalachian Kentucky, a region with significantly lower fruit and vegetable intake and higher rates of a range of diet related diseases than the US as a whole, the proposed project in Lee County, KY examines the feasibility of using a farm to school program, which provides locally-raised produce to the school cafeteria, as a health intervention. The proposed project will be sited in one of the two elementary schools in the county, both of which have free and reduced lunch qualification rates exceeding 78 percent, with the other school serving as a matched control site. Farm to school projects seek to increase student consumption of fruits and vegetables by linking local farms to school cafeterias; currently, however, there are no known empirically-based examinations of this promising, ecologically oriented approach to improving child nutrition. A multidisciplinary team, including an anthropologist, a health communications specialist, a biostatistician, and a public health nutritionist, will partner with school personnel, students, parents, and farmers in a Community Based Participatory Research program designed to develop, implement and assess a farm to school program in a low-income county in Central Appalachia. The Specific Aims of this project are 1) To tailor existing farm to school programs, using formative research, including the development of promotional media, for use in a low-income, high disparity Appalachian community; and (2) To implement and evaluate a pilot F2S program as a means of improving FandV consumption in a low-income Appalachian elementary school. During Phase I, the developmental phase, key informant interviews and focus groups will be conducted to gain insights into how to tailor existing farm to school programs from elsewhere in the US to the Central Appalachian setting. Formative research with school administrators and food service personnel, teachers, area farmers, students, and parents will guide modifications to model farm to school programs. Research team members will collaborate closely with community members in structuring key program components, farmer recruitment, and selection of produce. We will use social marketing techniques to design in-school promotional media, based on student suggestions and feedback from pilot testing. During Phase II, we will administer the intervention, using a nonequivalent control group design with pre and post tests. The primary outcome measure is the level of consumption of fruits and vegetables, measured using an innovative technique based on digital photographic assessment of cafeteria consumption. Outcome evaluation is complemented with extensive process evaluation. Upon project completion, we will apply and expand the findings of this ecologically oriented, CBPR project to create a large scale R01 project capable of reducing childhood obesity in a way enriching and acceptable to the community. PUBLIC HEALTH RELEVANCE: An important health risk faced by children in Appalachia is low intake of fruits and vegetables. This dietary deficiency can lead to a range of serious health consequences throughout life. Given the high levels of participation, particularly in lower income schools, the school lunch program is an important avenue to address this problem. The proposed project works with one Appalachian elementary school in Kentucky, as well as its surrounding community, to develop, implement, and assess a Farm to School program that brings locally grown produce into the cafeteria.